Healthy Blue
Living HMO
SM
every card.
Confidence comes with
®
Group Administrative Guide
Plan Year 2017
Thank you for choosing Healthy Blue Living as a health care
plan for your employees. By offering this wellness incentive plan,
you’re showing your commitment to your employees and their
health. We look forward to working with you this year.
This reference guide provides valuable information to help
you administer Healthy Blue Living and answer
questions your employees may have.
1
Employer guidance
Your responsibilities
Offering Healthy Blue Living to your employees comes with tasks for you. Here are your responsibilities:
Tell your employees to complete a health assessment, and remind them to have their primary care physician
complete and electronically submit their qualification form within the first 90 days of enrollment or renewal.
Give your employees instructions for taking the health assessment. They can take it by:
– Logging in to their member account at bcbsm.com.
– Clicking on the Health & Wellness tab, which will take them to Blue Cross® Health & Wellness,
powered by WebMD®.
– Clicking on the Healthy Living tab.
–Clicking Health Assessment.
Institute and maintain a smoke-free workplace.
Encourage employees to participate in wellness programs. See Page 8.
Remind your employees that they must select an in-network primary care physician to coordinate their care.
Required
program
Your requirements (by group size)
1–50 enrolled
employees
51–300 enrolled
employees
301–1000 enrolled
employees
1001+ enrolled
employees
Select at least one of
the optional programs
Select at least two of
the optional programs
Select at least three of
the optional programs
Select at least four of
the optional programs
Required
Required
Required
Required
Not required
1 time per year
2 times per year
2 times per year
Distribute healthrelated articles for
employees (brochures,
newsletter, posters)
2 times per year
2 times per year
2 times per year
3 times per year
Provide on-site class
or discounts for
weight loss
1 time per year
1 time per year
2 times per year
2 times per year
Provide healthy
foods in cafeteria and
vending machines
Ongoing
Ongoing
Ongoing
Ongoing
1 time per year
1 time per year
2 times per year
2 times per year
Ongoing
Ongoing
Ongoing
Ongoing
Provide smoke-free
environment
Optional programs
Health fair
Provide stress-relief
class
Provide discounts
to exercise facilities,
or exercise classes
2 times per year, or
exercise facility on site
WebMD Health Services is an independent company supporting Blue Care Network by providing health and wellness services.
2
Time frames for new hires
Here’s a breakdown of the timing for your new hires:
Hired in first or second quarter
Hired in third quarter
Hired in fourth quarter
Employee has enhanced benefits
for 90 days.
Employee has enhanced benefits
for 90 days.
Employee has enhanced benefits
for the remainder of the plan year.
The employee must complete the
plan requirements within the first
90 days of his or her effective date
for everyone on the contract to
keep enhanced benefits.
The employee must complete the
plan requirements within the first
90 days of his or her effective date
for everyone on the contract to
keep enhanced benefits.
At the start of the new plan year,
the employee must complete the
plan requirements within the first
90 days of his or her effective date
for everyone on the contract to
keep enhanced benefits.
Primary care physician does not need
to submit the qualification form
for the employee at the start of
the new plan year.
Rehires
Any employees reinstated within six months or less from the date their plan lapsed are placed into their former
benefits level. If the lapse is more than six months, Blue Care Network follows the new-hire process.
Employees who are terminated and then reinstated during the 90-day qualification period are given whatever remains
of their 90 days to complete the initial requirements.
Employees added retroactively
We discourage retroactive contract additions because adding an employee after the plan’s effective date will
jeopardize his or her ability to have the full 90 days to comply with initial enrollment requirements. You must notify us
of any enrollment changes before your plan’s effective date.
Employees older than 65 are eligible, too
Active employees and retirees older than 65 are eligible for Healthy Blue Living. However, if Medicare is the primary
health care coverage for an employee, retiree or covered spouse, that person cannot enroll in Healthy Blue Living.
Individuals eligible for Medicare may be able to enroll in a Medicare product. For detailed eligibility information, go
to medicare.gov.*
*Blue Care Network does not control this website or endorse its general content.
3
Guiding your employees
Plan requirements
At the start of the plan year, new employees automatically receive enhanced benefits for the first 90 days. To keep
them, they must meet plan requirements. If they don’t, everyone on their health care contract moves to standard
benefits on Day 91 and stays there for the rest of the plan year.
Renewing employees start at the level of benefits they had in the previous plan year. If they were most recently
at the enhanced benefits level, they’ll stay there as long as they complete all necessary requirements. If they
were at the standard benefits level, they’ll start the new plan year there, but can still work to meet the enhanced
requirements.
In 2017, Healthy Blue Living requirements will no longer apply to covered spouses. Only your employees will be
responsible for meeting the plan requirements. Your employees will earn everyone on their health care contract
enhanced benefits by completing the tasks below.
Earning enhanced benefits
Within the first
90 DAYS
of plan year
The employee must:
✓ Visit a Blue Care Network primary care physician and have the doctor complete
and electronically submit to us a Blue Care Network Qualification Form.*
✓ Meet six health measures or commit to the doctor’s treatment plan to
improve his or her health. See the next page.
✓ Complete a health assessment* by logging in to their account at
bcbsm.com. A paper copy can be requested by calling 1-855-326-5098.
Within the first
120 DAYS
of plan year
If the employee:
✓ Is a tobacco user, and he or she is ready to set a quit date, he or she
must enroll at no extra cost in Tobacco Cessation Coaching, powered
by WebMD. If he or she isn’t ready to set a quit date, then participating
in Lifestyle Coaching is required until the end of the plan year or until
the employee quits using tobacco. This must be confirmed by a new
qualification form showing a negative cotinine test.
✓ Has a body mass index of 30 or more — confirmed through his or her
qualification form — then he or she must enroll and participate at no extra
cost in our weight-management program until his or her BMI falls below 30.
If any employees are required to participate in our tobacco-cessation program or weight-management program,
we’ll send them letters with enrollment information.
Employees should consult with their primary care physician before starting any regular exercise or
weight-management program.
4
*Renewing employees who scored all A’s on their most recent qualification form may not need to complete another health assessment or qualification
form this year. How often they must meet requirements depends on their age. See Page 6.
Moving to standard benefits
All of your Healthy Blue Living employees have the same great benefits package as one another no matter which
benefits level they’re in. However, if an employee doesn’t meet the enhanced benefits requirements, everyone on the
employee’s health care contract moves to the standard benefits level on Day 91 and will stay there for the rest of the
plan year. That means higher out-of-pocket costs for everyone on the employee’s contract.
Blue Care Network is committed to helping members achieve their best health status. Rewards for participating in our wellness program, Healthy Blue Living, are
available to all contract holders who meet all qualification requirements. If any contract holder thinks they might be unable to meet a standard or requirement for
a reward under this wellness program, they might qualify for an opportunity to earn the same reward by different means. They can work with their BCN primary
care physician to find an alternative that’s right for them in light of their health status.
Doesn’t use (confirmed by primary
care physician through blood or
urine cotinine testing)*
a
ug
ssur
e
pre
oo
d
ds
r
Body mass index
below 30
ht
Healthy Blue Living focuses on six areas
of health that increase the likelihood of a
person developing a chronic or disabling
condition. These six health measures also
affect health care costs. One of the goals
of Healthy Blue Living is to help employees
achieve these wellness targets to avoid
illness and higher health care costs.
o
Blo
At or below target (fasting
blood sugar or A1C)
6 key health
measures
eig
W
Any depression
is in full remission
Dep
res
sio
n
Tobacco
Bl
Below 140/90
Cholesterol
LDL-C below target (based on
risk factors: <100, <130 or <160)
*After one negative test, no testing is needed again.
Self-reported tobacco users don’t need the test.
5
The ABCs of the Blue Care Network Qualification Form
Each health measure on the qualification form tracks an employee’s status using a simple “A, B, C” grading system.
A’s and B’s will earn an employee enhanced benefits and one or more C’s moves everyone on his or her contract to
standard benefits. C’s mean that an employee hasn’t met a wellness target and hasn’t committed to treatment to
improve a condition.
All A’s relax the rules
Completion of the health assessment and qualification form aren’t required every year for employees who scored all
A’s on their most recent qualification form. It’s required every two or three years, depending on their age. We’ll send
a letter to them when it’s time to complete a new health assessment and qualification form.
Under 40
40 or older
Every three years
Every two years
Age
How often
Qualification form status
We provide a paper qualification form in each employee’s renewal packet only as a sample of the form his or her
primary care physician electronically submits. Your employees should take the qualification form to appointments
to remind the doctor that he or she is enrolled in Healthy Blue Living. We don’t accept paper qualification forms.
Your employees can check online to see if their qualification form has been submitted. They can also view their
health measure grades, lab values, test results and requirements for weight management or tobacco cessation by:
• Logging in to their member account at bcbsm.com.
•Clicking My Coverage, Medical and then To-do List.
They can also call the Customer Service number on the back of their Blue Care Network ID card.
Auto renewal for our weight-management program
Employees whose qualification form still shows a BMI of 30 or more can continue in their program without
re-selecting it. If they want to switch programs, they can call the Customer Service number on the back of their
BCN ID card or log in to their account at bcbsm.com. Auto renewal applies only to employees who:
1) were compliant in the previous plan year; 2) are actively participating in a program; and 3) had their doctor
submit an updated qualification form showing their BMI is still 30 or more.
6
Member communications timeline
We send information and periodic reminders to new employees about what they need to do to earn and keep
enhanced benefits. Steps are similar for renewing employees.
Day 1: Enrollment
Day 7
Welcome kit, including qualification form and
personalized Member Handbook of benefits
Day 45
Reminder letter listing
incomplete requirements
Day 65
Recorded reminder phone call
about incomplete requirements
Day 105
Letter about outstanding online
health assessment, qualification form
or both, and standard benefit status
Up to day 110*
(To employees with a tobacco-cessation
or weight program requirement)
Letter and guide explaining details
and enrollment instructions
Up to day 121
Notice of contract’s drop to standard benefits
due to unmet tobacco or weight-management
requirement or missed deadline
30 days before group’s renewal date
Letter spotlighting upcoming plan year changes
2 weeks before end of plan year
Renewal kit to active employees with Member Guide
Up to day 364
Notice of contract’s drop to standard
benefits due to unmet tobacco-cessation,
weight-management requirement, or both
Day 365: End of plan year
*Varies by date we receive the qualification form
7
Let our health care plan work for your employees…
Member discounts
Members have access to exclusive discounts on a variety of health products and services from groceries and
fitness gear to travel and gym memberships. Members can take advantage of these offers and more by:
• Logging in to their member account at bcbsm.com.
•Clicking Member Discounts with Blue365® on the right side of the home page.
Digital Health AssistantSM programs
After members complete a health assessment, they’ll receive recommendations for WebMD’s Digital Health
Assistant online coaching programs. These include:
• Conquer Stress
• Enjoy Exercise
• Quit Tobacco
• Eat Better
• Lose Weight
• Feel Happier
The Digital Health Assistant programs help members set small, achievable goals that they commit to for one week.
They can choose activities, create plans and track their progress on the Blue Cross Health & Wellness site.
Publications
Employees receive a special issue of our award-winning Good Health magazine in the spring and fall. It’s loaded
with health tips and lifestyle advice. Health and wellness information is also online at facebook.com/MiBCN.
And everyone can sign up for our free monthly e-newsletter at bcbsm.com/enewsletters. Readers learn to improve
their health with articles, videos, tips and recipes.
24-Hour Nurse Advice Line
For no extra cost, members can speak to a registered nurse 24/7, toll-free at 1-855-624-5214 or 711 (TTY).
A registered nurse can answer health care questions, assess symptoms and provide self-care tips, and give
advice on making decisions about treatment options for a condition or disease.
Outstanding customer service
Our dedicated Customer Service representatives are trained to answer members’ questions and are just a toll-free
phone call away. Members can call the Customer Service number on the back of their Blue Care Network ID card.
8
…and for you
Group Secured Services
Using a secure, private, online account makes managing your health care plan
easier. Log in to your employer account at bcbsm.com any time to access helpful
tools and resources. Depending on your plan, you’ll be able to:
• View group and member information, add and update member contracts,
and request ID cards.
• Access your group account through eBilling.
• View, download and email benefit guides for employees.
• Receive wellness education materials to share with your employees.
Blue Care Network agents and sales representatives
Talk with them for guidance. They can help you make the best choices for
your business.
Blues Marketplace SM — Customer Edition
Our monthly e-newsletter provides news and information of special interest
to you. To sign up, log in as an employer at bcbsm.com.
Field Services
If your group has ten or more employees, call toll-free 1-877-465-5120 to have
a Blue Care Network field specialist assigned to you. You’ll get concierge-level
customer support, including claim and benefit assistance, on-site visits and
presentations to employees at open enrollment events.
bcbsm.com gives members the power to make
smart health choices.
When adult members sign up for a member account, it gives them:
An easier search: See what’s covered, and look up doctors, hospitals and
treatments in one spot.
The complete picture: Plan for surgery by knowing all services involved, each
of their estimated costs, and overall timing — from initial visit through therapy.
Healthy choices: Manage goals and fitness with Blue Cross® Health &
Wellness, powered by WebMD®.
9
Find us online:
bcbsm.com | news.bcbsm.com | facebook.com/MiBCN
ahealthiermichigan.org | twitter.com/bcbsm | youtube.com/bcbsmnews
CB 16049 AUG 16
Blue Care Network is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association.
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